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Psych Congress  

Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia

John Kane, MD; Ofer Agid, MD; Marjorie L. Baldwin, PhD; Christoph U. Correll, MD; Oliver Howes, MD; Jean-Pierre Lindenmayer, MD; Stephen R. Marder, MD; Mark Olfson, MD, MPH; Steven Potkin, MD

This poster was presented at the 30th annual  Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.

Treatment-resistant schizophrenia (TRS) occurs in approximately 30% of individuals diagnosed with schizophrenia (10%-20% of such individuals exhibit little/no treatment response at illness onset; 10%-60% of those who initially respond to treatment develop resistance over time). However, identifying and managing TRS in clinical practice is often inconsistent and not evidence-based because no established clinically relevant criteria for defining and treating TRS exist. This presentation summarizes the consensus of a 2017 roundtable on TRS (sponsored by Lundbeck) focused on definition and identification of TRS, pathways to treatment resistance, current treatments and unmet needs, and disease burden. Consistent with current recommendations, it was agreed that inadequate response to 2 different antipsychotics, each taken at adequate dose and treatment durations, are required to establish TRS. For each trial, objective symptom measures should be used to assess treatment response, and medication adherence must be assured. Once nonresponse is established (after a minimum of 12 weeks for positive symptoms [2 trials of _6 weeks]), the treatment plan should be reevaluated and alternative pharmacologic treatments, including clozapine, or nonpharmacologic interventions should be considered. With increased awareness, those involved in the care of individuals with schizophrenia will be able to identify TRS earlier in its course allowing for more informed treatment decisions by clinicians, patients, and families/caregivers to reduce the overall burden of the disease.

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